Politics, et Cetera
A publication from The Political Forum, LLC
Tuesday, February 19, 2013
They Said It:
The moment you abate anything from the full rights of men, each to govern himself, and suffer any artificial, positive limitation upon those rights, from that moment the whole organization of government becomes a consideration of convenience. This it is which makes the constitution of a state, and the due distribution of its powers, a matter of the most delicate and complicated skill. It requires a deep knowledge of human nature and human necessities, and of the things which facilitate or obstruct the various ends, which are to be pursued by the mechanism of civil institutions. The state is to have recruits to its strength, and remedies to its distempers. What is the use of discussing a man’s abstract right to food or medicine? The question is upon the method of procuring and administering them. In that deliberation I shall always advise to call in the aid of the farmer and the physician, rather than the professor of metaphysics.
Edmund Burke, Reflections on the Revolution in France, 1790.
THE FRUITS OF OBAMACARE.
Over the last several weeks, there has been a great deal of commentary about the mounting problems with the Affordable Care Act, or, as it is more commonly known, Obamacare. This was to be expected, of course. The program is in the implementation stage, heading toward a start date early next year, and there are bound to be glitches. After all, the government is hyper-bureaucratizing 1/6th of the national economy. And no one said that this would be easy. Right?
Well, yes. But judging from the commentary, the term “glitches” might be a little understated. In fact, phrases and words like “inflation,” “sticker shock,” “ruinous,” “inherent complexities,” and “public disapproval” seem to be cropping up with increasing frequency.
And while we may be wrong, our guess is that the language will become increasingly coarse as the process advances. Indeed, we will not be surprised if words and phrases like “deadly,” “destructive,” and “terrorism” begin to pepper the discussion. Think we’re nuts? Well . . . maybe so. But let us explain anyway.
In the annals of Islamist terrorism, the attack on the Glasgow International Airport nearly six years ago has been all but forgotten. No major or lasting damage was done to the airport terminal. Only five bystanders were injured, and then only superficially. The sole fatality was Kafeel Ahmed, one of the two bombers, who was badly burned in the attack. All of which is to say that it is unlikely that this incident will be immortalized among Islamism’s “greatest hits.”
Nevertheless, this was a significant incident, not because of the damage done but because of the people who perpetrated and conspired in the attack. Eight people were eventually arrested. And you know what? They all worked, in some capacity or another, for Britain’s National Health Service. Kinda spooky, huh? In a column published less than two weeks after the bombing, the inimitable Mark Steyn provided both the gory details and the relevance:
Of the eight persons arrested so far in connection with the terrorist plot, seven are doctors with the National Health Service (the eighth is the wife of one, and a lab technician at the same hospital). The bombs failed to go off because a medical syringe malfunctioned. I don’t mean it malfunctioned as a syringe (even in the crumbling NHS, the syringes usually work) but as a triggering mechanism, to which it had been adapted, though evidently not too efficiently.
Does government health care inevitably lead to homicidal doctors who can’t wait to leap into a flaming SUV and drive it through the check-in counter? No. But government health care does lead to a dependence on medical staff imported from other countries.
Some 40% of Britain’s practicing doctors were trained overseas — and that percentage will increase, as older native doctors retire and younger immigrant doctors take their place: According to the BBC, “Over two-thirds of doctors registering to practise in the U.K. in 2003 were from overseas — the vast majority from non-European countries.” Five of the eight arrested are Arab Muslims, the other three Indian Muslims. Bilal Abdulla, the Wahhabi driver of the incendiary Jeep and a doctor at the Royal Alexandra Hospital near Glasgow, is one of over 2,000 Iraqi doctors working in Britain. Many of these imported medical staff have never practiced in their own countries. As soon as they complete their training, they move to a western world hungry for doctors to prop up their understaffed health systems: Dr. Abdulla got his medical qualification in Baghdad in 2004 and was practicing in Britain by 2006. His co-plotter, Mohammed Asha, a neurosurgeon, graduated in Jordan in 2004 and came to England the same year.
Now, we know full well that it is difficult to draw exact parallels between Great Britain and the United States, particularly where health care and shortages of doctors are concerned. After all, Britain has had a nationalized system for decades, while the American system will not be fully nationalized this time around and the proposed “reforms” are still not fully in effect. All of which is to say that it is not entirely fair to extrapolate the British experience to America’s fledgling attempt at “reform.”
But then, we don’t have to extrapolate. A similar shortage of doctors here in the good old U.S. of A. is not hypothetical. And it does not hinge on “nationalization.” The doctor shortage is real and it will be severely exacerbated by the implementation of Obamacare. Consider, for example, the following, published last week by the Los Angeles Times, not exactly a hotbed of right-wing propaganda:
As the state moves to expand healthcare coverage to millions of Californians under President Obama’s healthcare law, it faces a major obstacle: There aren’t enough doctors to treat a crush of newly insured patients . . . .
As the nation’s earliest and most aggressive adopter of the healthcare overhaul, California faces more pressure than many states. Diana Dooley, secretary of the state Health and Human Services Agency, said in an interview that expanding some professionals’ roles was among the options policymakers should explore to help meet the expected demand.
At a meeting of healthcare advocates in December, she had offered a more blunt assessment.
“We’re going to have to provide care at lower levels,” she told the group. “I think a lot of people are trained to do work that our licenses don’t allow them to.”
Currently, just 16 of California’s 58 counties have the federal government’s recommended supply of primary care physicians, with the Inland Empire and the San Joaquin Valley facing the worst shortages. In addition, nearly 30% of the state’s doctors are nearing retirement age, the highest percentage in the nation, according to the Assn. of American Medical Colleges . . . .
Administrators of community clinics and public hospitals say nurse practitioners and other non-physician providers already play key roles in caring for patients, a trend they predict will grow as more Californians become insured and enter the healthcare system.
At Kern Medical Center in Kern County, two clinical pharmacists have run the hospital’s diabetes clinic, treating about 500 patients a year, since the specialist physician in charge retired. They are licensed to perform physicals, order lab tests, prescribe medicines and counsel patients on lifestyle changes.
“We’re going to have to get a whole lot more creative about how care is provided,” said Paul Hensler, Kern Medical Center’s chief executive.
Of course, there’s always the next graduating class from Mali Med, right?
In his indictment of the British system, Steyn argues that “no amount of gold can persuade Britons to spend their working lives in the country’s dirty decrepit hospitals . . . .” But, of course, the American system is manifestly not the same. Hospitals, doctors’ offices, clinics, etc. are neither dirty nor decrepit. They are, at least for the time being, perfectly adequate. And yet attracting new members to the profession is proving very difficult and is predicted to grow even more so as the years pass and as Obamacare becomes the norm. Indeed, rather than making the field more attractive, the Obama crowd is making it less so.
You see, throughout the debate over Obamacare and the subsequent three-year-long campaign to convince Americans that they should love the law that most of them hate (and that more will surely grow to hate), the focus of the Obama administration has been “bending the cost-curve downward,” which translates into English as “slashing the income of health care professionals.” The President himself left little doubt about which of the health care professionals are most responsible for inflating costs and are, therefore, most likely to be affected.
So we are going to be taking steps, as part of reform, to deal with expanding primary care physicians and our nursing corps. On the doctors’ front, one of the things we can do is to reimburse doctors who are providing preventive care and not just the surgeon who provides care after somebody is sick . . . .
All I’m saying is let’s take the example of something like diabetes, one of – a disease that’s skyrocketing, partly because of obesity, partly because it’s not treated as effectively as it could be. Right now if we paid a family – if a family care physician works with his or her patient to help them lose weight, modify diet, monitors whether they’re taking their medications in a timely fashion, they might get reimbursed a pittance. But if that same diabetic ends up getting their foot amputated, that’s $30,000, $40,000, $50,000 – immediately the surgeon is reimbursed.
Elsewhere, he added:
Right now, doctors a lot of times are forced to make decisions based on the fee payment schedule that’s out there . . . . The doctor may look at the reimbursement system and say to himself, “You know what? I make a lot more money if I take this kid’s tonsils out.” . . . Now, that may be the right thing to do, but I’d rather have that doctor making those decisions just based on whether you really need your kid’s tonsils out or whether it might make more sense just to change; maybe they have allergies. Maybe they have something else that would make a difference.
He didn’t say whether he gained this wisdom from a barber shop or a hamburger joint, but it is kind of scary to think that this was the kind of sophomoric garbage that was being kicked around in White House during the birthing process of this disaster. And for the record, according to the American College of Surgeons, a doctor is generally reimbursed between $740 and $1140 for an amputation. Of course, when you’re the guy who spends a billion borrowed Chinese dollars roughly every ten hours, no one can really expect numbers to mean a whole lot to you, can they?
Consider this. One of the most critical and most controversial components of the health care reform process was the creation of the Independent Payment Advisory Board, also known as the “death panel.” The explicit job of the IPAB is to cut costs in Medicare. That means that its function is to deny payments to doctors for expensive services – all of which fits perfectly into the Obama belief-system in which one of the most critical problems with health care in America is that doctors are simply getting paid too much. As Miriam Laugesen and Sherry Glied – the latter of whom is an Obama appointee at HHS – put it in a 2011 study, “We conclude that the higher fees [paid to physicians] . . . were the main drivers of higher U.S. spending.”
All of this comes against a backdrop of rapidly rising tuition and other associated costs for medical training. As with all higher-education over the last three decades, the cost of medical school has increased exponentially. As has the debt incurred by med students. Last summer, American Medical News, a publication of the American Medical Association, put it this way:
The mounting costs of getting a medical education continue to weigh heavily on medical students and graduates, many of whom leave school carrying large, three-figure debt loads.
Eighty-six percent of allopathic medical school graduates and 91% of osteopathic medicine college graduates had educational debt in 2011, according to the latest data from the Assn. of American Medical Colleges and the American Assn. of Colleges of Osteopathic Medicine. The average debt is $205,674 for osteopathic medicine students and $162,000 for allopathic students . . . .
“The issue of debt levels really looms large,” Dr. Wiley said. “We continue to be concerned about the rise. Stabilizing at an average of $162,000 is still extraordinarily high and is just financially out of reach for many applicants to medical school.”
A medical school graduate with $162,000 of debt would have monthly payments ranging from $1,500 to $2,100 after residency training, depending on the repayment plan, according to an AAMC report issued in July.
Note, by way of comparison, that the median existing home sales price in the United States last month was roughly $180,000. What that means, of course, is that while the Obama administration is actively seeking to cut physicians’ pay, to increase their workload exponentially, and to undermine the respect they’ve traditionally been afforded, new doctors are starting in practice carrying a debt load equivalent to that of the average American home. Is there really any question why physician shortages are forecast in California – and much of the rest of the country as well?
Again, in his indictment of the British system, Steyn insists that “government health care does lead to a dependence on medical staff imported from other countries.” In Britain and in Europe, this is undoubtedly the case. But don’t worry. That’s not going to happen in America. We’re going make our doctors work more for less and allow non-doctors to compete with these price-gouging bastards, at least according to the aforementioned LA Times article:
Some lawmakers want to fill the gap by redefining who can provide healthcare.
They are working on proposals that would allow physician assistants to treat more patients and nurse practitioners to set up independent practices. Pharmacists and optometrists could act as primary care providers, diagnosing and managing some chronic illnesses, such as diabetes and high-blood pressure.
Far be it from us to disparage any of the allied health care professionals. As far as we’re concerned, PAs, nurse practitioners, and the others are exceptionally valuable and serve a vital function in providing health care. At the same time, there can be little doubt that the training and pre-practice experience of allied health professionals does not compare in length or demonstrated proficiency to that of physicians. As the University of Washington physician’s assistant studies program description puts it:
One of the main differences between PA education and physician education is not the core content of the curriculum, but the amount of time spent in formal education. In addition to time in school, physicians are required to do an internship, and the majority also complete a residency in a specialty following that. PAs do not have to undertake an internship or residency.
What all of this means is that, in the aggregate, the level of care that Americans currently enjoy is going to take a very big hit, whether it’s in the form reduced visits and longer wait times, because of a shortage of doctors; reduced interaction with physicians and greater interaction with allied health professionals; or, perhaps someday in the future, massive numbers of “imported” doctors such as those who populate the British health care system. No one can say how damaging any of these developments might be. But they will be damaging. And they will lead to a higher level of death by misdiagnosis/mistreatment.
Still think we’re nuts? Again, maybe we are. But we’re also pretty sure that Obamacare is not only going to be the most radical policy development in recent memory, but also the most disastrous and the most hated. None of the promises made to the American people have been or will be kept. Huge numbers of workers are going to find that their employers are far more willing to pay fines than to mess around with the complexities of the new system. Huge numbers of Americans are going to find that their health insurance premiums have skyrocketed. And huge numbers of Americans are going to find that their level of care is dramatically diminished.
The mainstream (i.e. left-leaning) media have spent the last couple of weeks berating Dr. Ben Carson for allegedly “insulting” the President at the National Prayer Breakfast by noting the limitations of the current health care system and advocating greater exploitation of market forces in health care delivery. It never occurred to them, though, to wonder how bad things have to be – and how bad things are expected to get – to push a world-renowned neurosurgeon like Dr. Carson to make such a plea at such an event. If they had bothered to consider this, they might have begun to wonder if “the One and his “signature achievement” aren’t endangering them and their families.
They might, in short, begin to use words like “death,” “destruction” or even “terrorism,” when they consider the mess he’s making of what used to be called the “best health care system in the world.” If not now, then someday. Probably soon.
WHAT DOES IT MEAN WHEN A POPE CALLS IT QUITS?
We feel that we would be remiss if we let the first papal resignation in some six centuries pass without comment, particularly since we have commented on the papacy and its importance to Western Civilization countless times in these pages. At the same time, we’re not entirely sure that there is a whole lot to say about it, at least at this point. Our personal belief is that Benedict XVI is an exceptionally brave and intelligent man. His papacy has been defined by actions and struggles that will prove critical to the future of Catholicism, but also to Western Civilization itself. And yet his resignation strikes us as something of a non-event. At least from a near-term, geopolitical perspective, it’s a non-event. In short, this changes nothing.
Now, it may strike some of you as a mistake on our part to take a religious affair such as this and to look at it from “a near-term, geopolitical perspective.” And we agree. In fact, that’s basically our point. And if you can bear with us for a bit, we’ll do our best to explain.
Most of the mainstream coverage of Pope Benedict’s resignation has focused on the problems facing the Church and the “ideologies” of the men who might replace him. Typical of the genre was the following, published by the nation’s paper of record, The New York Times:
Saying he had examined his conscience “before God,” Benedict said he felt that he was not up to the challenge of guiding the world’s one billion Catholics. That task will fall to his successor, who will have to contend not only with a Roman Catholic Church marred by the sexual abuse crisis, but also with an increasingly secular Europe and the spread of Protestant evangelical movements in the United States, Latin America and Africa.
The resignation sets up a struggle between the staunchest conservatives, in Benedict’s mold, who advocate a smaller church of more fervent believers, and those who believe that the church can broaden its appeal in small but significant ways, like allowing divorced Catholics who remarry without an annulment to receive communion or loosening restrictions on condom use in an effort to prevent AIDS. There are no plausible candidates who would move on issues like ending celibacy for priests, or the ordination of women.
This is, to borrow a phrase from Bentham, nonsense on stilts. It’s crazy, to put it mildly.
Only the colossally narcissistic leftie Baby Boomers who presently run our mainstream media could think that the succession to the papacy – to the head of an institution that has existed almost TEN TIMES as long as the United States – is somehow about them and their personal political predilections. Only fools of monumental proportion could possibly think that this is a “battle” between “conservatives” and “liberals” and one centering on “issues” like remarriage and condoms. It’s funny. The Left is constantly accusing conservatives and others who fail to toe the cultural line of “eurocentrism” and the like, implying that Americans, Republicans, and other uncivilized creatures are too shallow and too self-absorbed to see issues from anyone else’s perspective and especially from the perspective of the beleaguered Third World. And yet, when it comes to religion, Christianity, the Catholic Church, and, in this case, the Pope, the smug lefties are, by far, the most odious offenders.
The idea that the papacy can be viewed through the lens of American politics is simply absurd. Moreover, the fools in the press are going to be heartily disappointed no matter what happens at the papal enclave next month if they believe otherwise.
Consider, if you will, the following, which comes from a piece we ran last March under the title “Religion and the Left.”
In this country, the United States Conference of Catholic Bishops (USCCB) has always been a strong defender of the unborn, unflinchingly making the case that abortion is an affront to human dignity and expressly denies one of those self-evident truths, namely that “all men are created equal, that they are endowed by their creator with certain inalienable rights, that among these are LIFE, Liberty and the Pursuit of Happiness.” The Bishops – and their clerical subordinates – have, as a result, been roundly criticized as too “conservative.”
It should be noted, though, that the USCCB is not necessarily conservative. And the presumption that the Catholic clergy necessarily agrees with the Republicans or with the Evangelical “religious right” is entirely mistaken. You see, while most of the American Bishops are deeply devout, profoundly intelligent, and unfailingly dedicated servants, they can, collectively, be quite naïve on occasion and, dare we say it, every bit as obtuse and foolish as Rowan Williams. In fact, the USCCB, like Williams, is the author of many of its own problems and specifically a co-author of one of the biggest problems that is plaguing the Catholic Church in America today; the one that began two months ago when the Obama administration decreed that all employers in the country, including religiously affiliated hospitals, colleges, and charities, would henceforth be required to offer insurance coverage that provides no-cost contraception and abortifacient coverage for female employees.
Of course, the Bishops cried foul and have been crying foul ever since. Yet, a perusal of the USCCB’s web site provides a veritable treasure trove of documents and policy statements linking them to the petard upon which they now find themselves hoisted, which is to say the type of left-leaning, centrally planned government that tends to disregard economic and geopolitical reality as it makes decisions for erstwhile freeborn men and women . . ..
The American Bishops notoriously opposed welfare reform, objecting to the notion that reducing dependency should take priority over reducing poverty and challenging the idea that “work” is always the best option, particularly if “family responsibilities” might be compromised by work schedules. The American Bishops have always favored – and continued to favor – a strong social safety net and have argued for even economically deleterious extensions of welfare benefits. Most notoriously of all, of course, particularly in light of the current debate over health care and religious freedom, is the USCCB’s longtime advocacy of health care “reform.” As the USCCB’s Department of Justice Peace and Human Development put it thirteen months ago, as we neared the one year anniversary of Obamacare’s passage:
For decades, the bishops have consistently insisted that access to decent health care is a basic safeguard of human life and an affirmation of human dignity from conception until natural death. Health care reform legislation and implementation should be supported that 1) ensures access to quality, affordable, life giving health care for all; 2) retains longstanding requirements that federal funds not be used for elective abortions or plans that include them, and effectively protects conscience rights; and 3) protects the access to health care that immigrants currently have and removes current barriers to access.
In A Framework for Comprehensive Health Care Reform: Protecting Human Life, Promoting Human Dignity, Pursuing the Common Good, the bishops support health coverage that is affordable for the poor and needy, moving our society substantially toward the goal of universal coverage. The bishops are equally clear in stating that this must be done in accord with the dignity of each and every human person, showing full respect for the life, health and conscience of all.
The Bishops, after years of dreaming the undreamable dream, finally have what they’ve always wanted, the prospect of universal coverage, or at least something close to it. And yet they are shocked – SHOCKED! – that the gol-derned government is using the power it has grabbed to . . . well . . . do whatever it wants, even to trample on the rights of its erstwhile comrades in arms. We don’t mean to be insulting, or rude, or – Heaven forbid – sacrilegious, but . . . ummm . . . duh! Who didn’t know?
As we also noted in that piece, the American Bishops are notoriously left-ish on matters of national security, economic policy, and such things as the minimum wage. What all of this means, then, is that even if the mainstream media folks got their wish, and the cardinals abandoned Benedict’s course, choosing a “liberal,” they would still get no satisfaction whatsoever on the issues that they think matter most, namely abortion, divorce, and the current brouhaha over mandatory contraception coverage. Even the “liberals” in the Church oppose the “liberals” in the media on these matters.
The fact of the situation is this: no matter whom the cardinals elect next month, the new Pope will have his immediate agenda pre-planned for him. He will have no choice whatsoever but to continue in the path originally trod by Benedict. His three greatest challenges will be: to restore the faith in its historical homeland, which is to say Europe, where “faith” has long been replaced by “nihilism; to fight the spread of radical and anti-“infidel” Islam; and to clean up the Church’s internal problems, ranging from the priest-pedophile scandal to the Church bank scandal.
That’s it. That’s the agenda. That’s the mission of the global Church over the next several years. The speculation about divorce and condoms and other irrelevancies is pure leftist fantasy. Even if the Church goes as far to the left as is possible, the American liberals will find no satisfaction whatsoever. None. Period. And the reason is simple: the issues on which they want satisfaction are simply not open for debate.
We will miss Pope Benedict. We truly will. He is a religious intellectual in an era in which “religion” and “intellectualism” are generally considered to be antithetical. More to the point, as a religious intellectual, he has been a steadfast activist in the mission most notably pursued by Thomas Aquinas, reconciling faith with reason. His scholarly and spiritual energy will be missed – and not just by Catholics.
At the same time, we really don’t believe that the hyperventilation and speculation serves any purpose. Like we said, from a global perspective, this is a non-event.
The Church on April 1st will be same the Church it was on January 1st, which, by the way, is the same Church it was last January 1st, and the January 1st before that, and the one before that, and the one before that, dating back nearly some twenty centuries. And that’s the point. The Church is the Church is the Church. And it always will be.
The rest is mere narcissistic daydreaming.